The Gender APP Gap: How Indian Women are Left Behind in Digital Healthcare
By Arunima Rajan
We will explore the issue of digital inequality in healthcare and its impact on women in India.
It is a universal truth that healthcare is a fundamental human right. But what happens when the decision-making power is taken away from the very people who require that right the most? In India, a country where patriarchy reigns supreme, it is not uncommon for women's healthcare decisions to be made by men - be it choosing the hospital for surgery or deciding whether to opt for a C-section. With the advent of digital healthcare solutions such as telemedicine and m-health apps, one might have hoped for a level playing field.
But the harsh reality is that access to these services is far from equitable. In small towns, women may have a cell phone but no internet connectivity, and even if they do have access, they may not know how to download and use the required apps. This digital divide hits particularly hard in poorer households, where access to the internet is a luxury.
Dr. Milind Khadke, the Director of Medical Services at Jaslok Hospital & Research Centre, believes that one of the most important aspects of a good healthcare system is easy accessibility for patients. Unfortunately, in India, there are only 0.5 hospital beds per 1000 people, compared to the international standard of at least two beds per thousand people. This ratio is further skewed in favour of urban populations, leaving rural areas with limited healthcare infrastructure.
To improve accessibility, digital platforms have been launched to connect patients with quality healthcare. During the COVID-19 pandemic, telemedicine became increasingly popular as a means of enhancing patient access to doctors. Many hospitals have launched or upgraded their websites to provide information about the hospital, available doctors, appointments, payments, diseases, and treatments. However, there is a concern regarding digital inequality across India.
The first issue is access to the internet. According to "India Inequality Report 2022: Digital Divide," only 31% of the rural population uses the internet, compared to 67% of their urban counterparts. Women in India are also less likely to own mobile phones or use mobile internet services than men. As a result, they constitute only one-third of internet users in India.
The second issue is access to hospitals. Patients often choose a hospital based on its proximity to their home, the availability of specialists, and their financial situation. Word-of-mouth recommendations from friends and family are often preferred to searching for medical help on the internet. Additionally, those who do use the internet to find medical help are not able to access comparisons of clinical outcomes for different treatments.
The third issue is electronic medical records. While most public and private hospitals have hospital information systems, they are often underutilised when it comes to medical documentation. These systems are commonly used only by ancillary departments such as procurement and finance. There is a need to have patient medical records in a common format that is easily accessible to patients wherever they receive treatment. A digital locker for health records that can be accessed at any time by the patient is essential. However, privacy concerns must also be addressed.
In conclusion, efforts to bridge the digital divide should focus on providing internet access to rural areas, particularly for women, consolidating medical information for patients online while maintaining strict privacy measures, and providing integrative solutions to India's fragmented healthcare system.
Definition of Digital Inequality in Healthcare
Ritu Hasija, Director, Corporate of Alniche Life Sciences, a pharmaceutical company headquartered in New Delhi, highlights the pressing issue of digital inequality in healthcare. “This issue is pervasive across the globe and refers to unequal access to digital resources, including computer technology, mobile devices, and internet connectivity. The lack of access to such resources severely impacts the ability of both healthcare providers and patients to obtain optimal care. Those without access to technology may not be able to benefit from remote healthcare services or digital tools to monitor their health. Furthermore, digital inequalities can exacerbate disparities in healthcare quality, where those with access to digital resources may have access to superior care and medical information than those without. Ultimately, digital inequality in healthcare can result in unequal health outcomes and disparities in accessing critical medical treatments,” she says
The Impact of Digital Platforms on Women’s Health and Wellness
The increasing use of smartphones and online tools in India has revolutionised the way women manage their maternal care and parenting responsibilities. Digital solutions have the potential to empower women and promote gender equality in healthcare. Mylo, a leading one-stop pregnancy and parenting solution conducted a survey with over 4600 women across India to understand the impact of technology on Indian women’s experience with parenting, childcare and healthcare access. The survey found that women rely on digital platforms to find tips and resources on parenting and childcare due to instant access to information and personalised responses from peers. Women emphasised the ease of communication and the strong sense of community that they build with other mothers through digital platforms, along with the convenience of accessing information and medical consultations remotely. Overall, 72% of women reported that technology has improved their and their child's health and wellness experience.
Shaveta Gupta, Head of Content & Community at Mylo, commends the revolutionary impact of technology on maternal care and parenting in India. She notes that digital solutions have become increasingly ubiquitous and user-friendly, empowering women to rely on them for guidance, support, and information. Gupta highlights the versatility of digital platforms, which offer remote consultations with medical professionals, access to personalised content, and opportunities to foster supportive communities. Ultimately, Gupta believes that online tools have seamlessly integrated into women's lives, facilitating the management of their time and responsibilities.
India’s Digital Gender Gap: Only One-Third of Women Have Ever Used the Internet
In spite of India's swift progress in internet accessibility, especially through mobile internet usage, the gender gap in digital access is still a pressing issue. The National Family Health Survey-5 data, covering the period of 2019-2021, conducted its inaugural assessment of internet use among Indian men and women. Shockingly, the results showed that a mere one-third of Indian women (33%) have ever used the internet, while more than half of Indian men (57%) have accessed it. Recent data shows that men are nearly twice as likely as women to have accessed the internet, with 49% of men reporting internet use compared to a mere 25% of women.
Closing the Gendered Digital Divide in Healthcare
Rajashree Menon, the Business Head of Healthcare at GOQii, points out that India is responsible for half of the world's gendered digital divide. Only a third of internet users in the country are women, which highlights the digital disparities in healthcare that disproportionately affect women despite the advancements in technology. The discrepancy is evident in the limited access to digital healthcare services and the underutilization of digital health tools and resources, including electronic health records, mobile health apps, telehealth, and other similar tools.
The conventional wisdom that women are less likely to use digital health tools and resources is attributed to a range of factors, including cultural barriers, a lack of understanding of how to use them, and distrust of digital health services. However, preventive healthcare organisations like GOQii have taken steps to address this issue. By creating a user-friendly 'Women care Feature' within their GOQii app, women can proactively monitor their health with guidance from their personal coach, specifically targeting menstruation and ovulation-related challenges. This empowers women to take control of their health and life. By addressing this digital divide, organisations like GOQii are ensuring that everyone has access to the care they require, regardless of their gender.
Lupin Digital Health, led by CEO Sidharth Srinivasan, has been working hard to enhance the heart health of millions of Indians through Digital Therapeutics, with a particular focus on women. LYFE, their digital therapeutic solution, has been designed by top Indian cardiologists and offers doctor-connected online and offline modules that improve patients' quality of life, reduce stress and anxiety for caregivers, and enable seamless monitoring of patients' vitals through connected devices. Currently, 35% of LYFE programme patients are women, and LDH is striving to improve this number further. Women have exhibited a higher level of adherence to the treatment protocol, with the average improvement in systolic blood pressure being 44% higher than male patients. To raise awareness and enhance health outcomes, LDH is providing women with complimentary specialised diet counselling this International Women's Day, as well as a special discount to make the solution more accessible to women patients. LDH intends to offer affordable and highly beneficial digital healthcare solutions for women across India through LYFE, which can be accessed from the comfort of their own homes. To provide patients with a superior disease and lifestyle management solution, LDH has personalised the vital monitoring aspect of the solution for each patient. By amalgamating connected devices, easy-to-use applications, and dedicated coaches and care managers, LDH believes that a holistic approach to digital healthcare can bridge the gender accessibility gap in India and lower the risk of re-hospitalisation, re-occurrence, and resurgence of symptoms for all patients, including women.
According to Dr Deepak Patkar, women can play a critical role in shaping the development and implementation of digital health technologies, particularly in low-income and vulnerable populations. Women's perspectives and experiences can provide valuable insights into the barriers they face in accessing digital health technologies and the types of interventions that are most effective. Additionally, involving women in the design and implementation of digital health interventions can help ensure that these interventions are culturally appropriate and responsive to the needs of women in these populations.
He continues: “There are several successful digital health interventions that have specifically addressed gender inequality in healthcare. For example, in Uganda, a mobile phone-based system was developed to provide women with information about family planning and maternal health. The system uses interactive voice response technology and is accessible to women with limited digital literacy. In India, a program was implemented to provide women with access to digital health tools through community health workers. The program was successful in increasing women's knowledge of maternal health and family planning and improving their access to healthcare services. These examples highlight the importance of addressing the barriers that women face in accessing digital health technologies and the need for interventions that are responsive to women's needs and experiences.”